The Epidemic Arrives
The new influenza virus arrived in Virginia late in the summer of 1918, apparently brought by soldiers arriving to take ships from Norfolk and Newport News to the war in Europe. It also appeared among personnel at U.S. Navy and Army facilities, and by September it began to spread throughout the state. It was a shift from more familiar influenza viruses, and almost no one had immunity to it. It caught the public and most health professionals unaware. At the time it was often called “Spanish Influenza” because of early reports in Spanish newspapers, but it did not originate in Spain. The general consensus among experts is that it originated in Kansas, with the first documented cases in U.S. Army facilities there, and then jumped to civilian populations. No one was prepared for what followed. It spread overseas among U.S. soldiers traveling to Europe to fight in World War I and then moved around the world. In the United States an estimated 25 percent of the population caught the disease and approximately 670,000 died, more than the number of U.S. military deaths in all U.S. wars combined (excluding the Civil War). More than 50 million people died worldwide, making it one of the worst epidemics in world history.
This influenza was highly contagious and a sudden killer, producing high fever, nausea, aches, and sometimes diarrhea. Weakened by influenza, many people caught severe pneumonia that destroyed the lungs, filling them with a frothy, bloody fluid; some patients turned blue from lack of oxygen. The disease struck hardest at people between twenty and forty years old, whereas ordinary flu tended to be most dangerous to young children and the elderly. Overall, roughly half of influenza victims were young and middle-aged adults, which meant that the disease left many orphans.
Attempts to Control the Influenza Pandemic
By 1919, when the epidemic ended, the Virginia State Board of Health reported that in just thirteen months 326,195 people in Virginia had caught the disease and, based on death certificates, 15,679 of those had died. The actual total was higher because some people in rural, isolated areas had no access to physicians and so no death certificates were filed.
Caring for the Sick
Doctors and nurses who worked with influenza patients were pushed to exhaustion. In the face of so many patient deaths, most doctors felt powerless, which shook the faith of many in the ability of modern science to successfully confront infectious diseases. (Viral infections are often untreatable and medical science at the time had not identified the existence of viruses.) Doctors used the treatments they knew, but these usually made no difference. Some medical authorities thought that alcohol might prove effective, and some officials across the state petitioned Governor Westmoreland Davis to allow larger amounts to be supplied to pharmacies. (At the time alcohol was prohibited in Virginia and could be sold only by pharmacists to fill a doctor’s prescription.) Nurses played a large role in their patients’ survival by keeping them warm, fed, and hydrated. As a result they tended to feel less hopeless than doctors. Still, some doctors and nurses caught influenza and a few died.
Even though most people were cared for at home by relatives, sometimes brave volunteers helped their neighbors or, in cities, even strangers. Women with nursing experience were called to volunteer in temporary emergency hospitals, and many responded. But in rural areas, the full weight of coping fell on family, with the healthy members working to keep the sick warm, fed, and clean—and in worst cases to bury them in local church or family cemeteries. In some cases neighbors left food on the porch for stricken families, and in cities groups of volunteers worked together to cook soup and sometimes bread to take to families struggling to care for relatives.
Pharmacists filled doctors’ prescriptions and also sold patent medicines that were advertised as preventing or treating the flu. Sometimes their supplies ran out entirely and they had trouble getting what they needed. Also they had trouble keeping up with doctors’ demands for medicines. (At the time, pharmacists compounded all medicines themselves from ingredients they kept in stock.) The majority of these treatments, however, were ineffective.
Undertakers were overwhelmed during the worst months of the epidemic. There was a shortage of coffins, and it was hard to bury the dead fast enough. In Philadelphia, one of the worst-hit cities, authorities were at times forced to bury bodies in mass graves, but this never happened in Virginia. In at least one case, in Tidewater, an undertaker donated land for burying the dead.
Government Response in Virginia
Taking their lead from the U.S. Public Health Service, federal authorities at first downplayed the importance of the deadly new influenza. Various announcements led people to think that this influenza was normal and could be handled by the usual treatments. Virginia officials at first followed suit. But, along with other state and local governments, they soon realized that they were dealing with something much worse.
When the epidemic began in Virginia the Red Cross immediately began to coordinate its work with the State Board of Health. On October 4, 1918, the board formally requested the cooperation of the Virginia Anti-Tuberculosis Association, a large and well-organized group already experienced in work on lung diseases. The board also requested that the Medical College of Virginia and the University of Virginia release its third- and fourth-year medical students so they could volunteer to help. The medical schools agreed, and some students assisted overwhelmed doctors and health-care providers.
The Board of Health did not have the power to impose health measures; it could only make recommendations to local governments and distribute public health information about prevention. But during the worst period of the epidemic—October–November 1918—the board organized a relief train with supplies, doctors, and nurses to help the especially hard-hit communities of Southwest Virginia.
President Woodrow Wilson made no official statements about the epidemic, thinking that if Americans were aware of the extent of the crisis their morale would suffer during wartime. There is no record of Governor Davis making any public statements about the crisis, either.
Richmond and Charlottesville
Richmond was the largest city in the state, with a population of approximately 170,000. Charlottesville and Albemarle County, with a combined population of 36,000 (11,000 for the city and 26,000 for the county), illustrate the experience of the influenza pandemic in small cities and rural areas.
Camp Lee During World War I
By the end of September, hundreds of cases of influenza had appeared in Richmond, with the number growing very fast. At this point, the city health officer and the Virginia Health Commissioner did not take steps to limit public gatherings or quarantine patients, and the public schools remained open. By the end of the first week of October, however, there were an estimated 10,000 cases in Richmond and authorities predicted 1,500 deaths within the coming six weeks. In response, Richmond health authorities prohibited gatherings at churches, theaters, movie houses, and other places where large numbers of people came together; soon schools were closed. Also, the State Fair was cancelled.
As the crisis deepened, Richmond officials and medical leaders issued calls for doctors, nurses, and others to volunteer. The city was helped by the presence of the Medical College of Virginia, which made its doctors and medical students available during the crisis. Volunteer nurses (trained and untrained) worked in groups alongside the city’s public health nurses and in local hospitals and the emergency hospitals. The city council converted an unused high school into a 500-bed emergency hospital (for whites only); it filled up quickly. The nursing shortage there was dire, and doctors called for all nurses regardless of race to volunteer at the hospital. The city soon opened two more emergency hospitals, one for whites and one for African Americans. The hospital at the state penitentiary filled with convict patients. In addition, Richmond churches established soup kitchens to provide food for households where families were too sick or too poor to provide for themselves.
By late October, the worst of the crisis seemed to have passed, and in early November restrictions on social gatherings ended and schools reopened, although against the advice of local doctors. Perhaps as a result, another surge of cases occurred early in December. By the end of the year 20,841 cases of influenza had been reported in Richmond, and by early February 1919 1,078 of those patients had died. Richmond’s death rate—attributable to many factors, including the government’s response—was lower than that of other cities on the East Coast but was higher than the average for southern and Midwestern cities.
The situation in Charlottesville and Albemarle County was similar in some ways. The first influenza death reported in the county was on September 30, 1918, and the disease hit hard and fast in early October. On October 4, the city council prohibited all large public gatherings, and schools soon closed. Overall, an estimated 2,100 residents caught influenza, and, based on death certificates, at least 227 died in the city and county combined. In addition, in remote rural areas, especially in the mountains in the western part of the county, others died without a doctor’s care and were buried at home.
The presence of the medical school at the University of Virginia was especially beneficial. The community hospital had only 20 beds, but University Hospital had 200, most of which filled with influenza patients in early and mid-October. University Hospital’s medical and nursing care—and the volunteer medical students—made a major difference in the community’s ability to handle the epidemic.
The city council issued several calls for volunteer nurses to work with the city’s pubic health nurse to care for patients, as well as calls for volunteers to help with providing food for the sick who did not have assistance. The home economics teacher at the Colored Graded School (later the Jefferson School), and her volunteers, made soup with donated ingredients.
Forgetting and Remembering
In the years after the epidemic, it seemed to fade from public memory. National leaders made no public statements about the way the country rallied around and confronted it. With one exception at the University of Montana, there are no monuments, statues, or plaques in the United States that commemorate the many who died or that praise the nurses, doctors, and volunteers who treated the millions who caught “Spanish flu.” One reason is that in Virginia and around the world the epidemic was overshadowed by war news at the time and because the postwar world had many difficult problems. The Great Depression of the 1930s was a terrible time for the United States and the world, and then World War II broke out. Another reason is that ordinary influenza was common, so that in retrospect many people thought of the 1918–1919 epidemic as an unusually bad occurrence of a familiar disease (rather than the new killer it was). Later, however, the flu epidemics of the 1950s to the 1970s raised consciousness of the harm of new varieties of influenza. By the 1990s, journalists writing about new influenza outbreaks began to routinely mention the ravages of the 1918–1919 epidemic, and historians wrote major books about it. In the 2000s the epidemic began to feature in novels, movies, and TV specials; and major articles on it appeared in national publications as the 100th anniversary approached in 2018.